Responsiveness of a 1-Year Recall Modified DASH Work Module in Active Workers with Upper Extremity Musculoskeletal Symptoms

Objectives To evaluate the responsiveness to change of a modified version of the Work module of the Disabilities of the Arm, Shoulder, and Hand (DASH-W) in a prospective, longitudinal cohort study of active workers. Methods We compared change on a 1-year recall modified DASH-W to change on work ability, work productivity, and symptom severity, according to predetermined hypotheses following the Consensus-based standards for the selection of health measurement instruments (COSMIN). We evaluated concordance in the direction of change, and magnitude of change using Spearman rank correlations, effect sizes (ES), standardized response means (SRM), and area under the receiver operating characteristic curves (AUC). Results In a sample of 551 workers, change in 1-year recall modified DASH-W scores showed moderate correlations with changes in work ability, work productivity, and symptom severity (r = 0.47, 0.44, and 0.36, respectively). ES and SRM were moderate for 1-year recall modified DASH-W scores in workers whose work ability (ES = ?0.58, SRM = ?0.52) and work productivity improved (ES = ?0.59, SRM = ?0.56), and larger for workers whose work ability (ES = 1.24, SRM = 0.68) and work productivity worsened (ES = 1.02, SRM = 0.61). ES and SRM were small for 1-year recall modified DASH-W scores of workers whose symptom severity improved (?0.32 and ?0.29, respectively). Responsiveness of the 1-year recall modified DASH-W was moderate for those whose symptom severity worsened (ES = 0.77, SRM = 0.50). AUC met responsiveness criteria for work ability and work productivity. Conclusions The 1-year recall modified DASH-W is responsive to changes in work ability and work productivity in active workers with upper extremity symptoms.     

Work Incapacity and Treatment Costs After Severe Accidents: Standard Versus Intensive Case Management in a 6-Year Randomized Controlled Trial

Purpose Case management is widely accepted as an effective method to support medical rehabilitation and vocational reintegration of accident victims with musculoskeletal injuries. This study investigates whether more intensive case management improves outcomes such as work incapacity and treatment costs for severely injured patients. Methods 8,050 patients were randomly allocated either to standard case management (SCM, administered by claims specialists) or intensive case management (ICM, administered by case managers). These study groups differ mainly by caseload, which was approximately 100 cases in SCM and 35 in ICM. The setting is equivalent to a prospective randomized controlled trial. A 6-year follow-up period was chosen in order to encompass both short-term insurance benefits and permanent disability costs. All data were extracted from administrative insurance databases. Results Average work incapacity over the 6-year follow-up, including contributions from daily allowances and permanent losses from disability, was slightly but insignificantly higher under ICM than under SCM (21.6 vs. 21.3 % of pre-accident work capacity). Remaining work incapacity after 6 years of follow-up showed no difference between ICM and SCM (8.9 vs. 8.8 % of pre-accident work incapacity). Treatment costs were 43,500 Swiss Francs (CHF) in ICM compared to 39,800 in SCM (+9.4 %, p = 0.01). The number of care providers involved in ICM was 10.5 compared to 10.0 in ICM (+5.0 %, p < 0.001). Conclusions Contrary to expectations, ICM did not reduce work incapacity as compared to SCM, but did increase healthcare consumption and treatment costs. It is concluded that the intensity of case management alone is not sufficient to improve rehabilitation and vocational reintegration of accident victims.     

Within-person fluctuations in wellbeing and task-specific work ability

Purpose

To research within-person fluctuations in occupational health, work ability and wellbeing, we need new measurement strategies. We studied absolute agreement for weekly measurements of task-specific work ability and relationships between wellbeing, work demands and personal factors and task-specific work ability over time.

Methods

Forty-eight Dutch academic researchers answered questions during 12 consecutive weeks. Physical and mental work demands, indicators of wellbeing and task-specific work ability in each week were measured. Intra-class correlation coefficients (ICC) for absolute agreement between task-specific work ability measures were calculated. For application in individual workers, an ICC?>?0.90 was regarded as suitable. Multilevel models were used to relate both time-invariant and time-varying predictors to task-specific work ability.

Results

Multiple measurements increased the reliability. Absolute agreement, however, did not reach the optimal level, except for the task ‘ability to conduct data analyses’ which had an ICC value of 0.95 (95% CI 0.91–0.98). Individuals’ leisure time physical activity (p?=?0.03) and relational (p?=?0.02) and social (p?=?0.02) wellbeing were related to their average task-specific work ability. Weekly physical demands (p?=?0.01) and personal (p?=?0.04) and general wellbeing (p?=?0.03) were related to weekly fluctuations in work ability.

Conclusions

We demonstrated intra-individual variability in repeated assessments of task-specific work ability, pointing to the need for multiple measurements when characterizing work ability. The finding that some time-invariant and time-varying predictors can be related to the estimate of aspects of task-specific work ability and its fluctuations is helpful in understanding the dynamics of this concept.

     

Measuring the Virtues and Character Traits of Rehabilitation Clients: The Adapted Inventory of Virtues and Strengths

Purpose To develop the Adapted Inventory of Virtues and Strengths (AIVS), a measure of rehabilitation clients’ virtues and character traits. Methods Test items were devised through a multi-step procedure, and exploratory factor analysis was employed to derive the factor structure of the AIVS. Item-total correlation and internal consistency (Cronbach’s α) were examined to test reliability of the AIVS. Results AIVS subscales include Emotional Transcendence, Practical Wisdom, Integrity, Courage, and Commitment to Action. Construct validity of this measure was evaluated by correlating AIVS factors with measures of resilience, life satisfaction, and four types of well-being: physical, psychological, financial, and family and social well-being. AIVS subscales of Emotional Transcendence and Commitment to Action were moderately correlated with life satisfaction and three well-being areas, including family and social, physical, and psychological life. Most of the correlation coefficients between AIVS Practical Wisdom, Courage and Integrity factors and measures of life satisfaction and well-being fell below r = .3. However, greater correlations were found between all AIVS factors and resilience. Reliability information was examined through internal consistency (coefficient alpha) for each AIVS subscale, as well as examination of item-total correlation analysis within each subscale. Internal consistency estimates for AIVS subscales ranged from .77 to .84. Conclusion The AIVS is a reliable measure when used with the studied sample; implications for studying virtue and character strengths in rehabilitation, as well as potential for clinical use of the AIVS, are addressed.     

Association of Low Back Pain,Impairment, Disability &; Work Limitations in Nurses

Introduction: Health care professionals use measures of pain and impairment to identify potential disability and subsequently to predict workers’ ability to do their work. However, there is little evidence that measures used are associated with ability to do one’s job. Methods: A cross-sectional study was conducted. Nurses (n = 100) were classified into either off/modified work (due to LBP) or regular work groups. Trunk ROM, trunk muscular endurance, pain and disability were measured relative to the outcomes work status and Work Limitations Questionnaire (WLQ) score. Results: Regression analyses which included Roland Morris Questionnaire (RMQ, disability) and Sørenson (back extensor endurance) in the final models correctly classified the work status of 87% of the participants and accounted for 60% of variance in the WLQ score. Conclusions: Use of the RMQ and Sørenson test as diagnostic and prognostic tools should be considered in assisting return to work and treatment decision-making in female nurses with LBP.     

Enabling Work: Occupational Therapy Interventions for Persons with Occupational Injuries and Diseases: A Scoping Review

Purpose This review aims to map the scope of published research on occupational therapy (OT) interventions and pertinent work and work-related outcomes for persons with occupational injuries and diseases. Methods The scoping review adapted Arksey and O’Malley’s framework. Six electronic databases were searched. Ancestral search was also done on five systematic reviews. The search was conducted from September 2015 to October 2015. Interventions and outcomes were coded using the International Classification of Functioning, Disability and Health Core Set for Vocational Rehabilitation to plot trends. Results Forty-six articles were included in the review. The top five intervention approaches included: acquiring skills (12.27%), health services, systems, and policies (10.43%), products and technology for employment (9.20%), handling stress and other psychological demands (7.98%), and apprenticeship (6.74%). The top five outcomes targeted included: remunerative employment (15.71%); sensation of pain (10.99%); emotional functions (5.76%); handling stress and other psychological demands (5.76%); economic self-sufficiency (4.71%); muscle endurance functions (4.71%); exercise tolerance functions (4.71%); undertaking multiple tasks (4.19%); acquiring, keeping, and terminating a job (4.19%); and looking after one’s health (4.19%). Conclusion The trend in interventions show the use of activities and environment facilitators which are attuned to the conceptual nature of OT. Furthermore, the trend in outcomes show that there is substantial evidence that supports the use of OT to target work. This review may provide a platform for collaboration with other professionals and also help identify research directions to strengthen the evidence base for OT in work-related practice.     

Measurement Properties of the Modified Spinal Function Sort (M-SFS): Is It Reliable and Valid in Workers with Chronic Musculoskeletal Pain?

Purpose To analyze the reliability and validity of a picture-based questionnaire, the Modified Spinal Function Sort (M-SFS). Methods Sixty-two injured workers with chronic musculoskeletal disorders (MSD) were recruited from two work rehabilitation centers. Internal consistency was assessed by Cronbach’s alpha. Construct validity was tested based on four a priori hypotheses. Structural validity was measured with principal component analysis (PCA). Test–retest reliability and agreement was evaluated using intraclass correlation coefficient (ICC) and measurement error with the limits of agreement (LoA). Results Total score of the M-SFS was 54.4 (SD 16.4) and 56.1 (16.4) for test and retest, respectively. Item distribution showed no ceiling effects. Cronbach’s alpha was 0.94 and 0.95 for test and retest, respectively. PCA showed the presence of four components explaining a total of 74% of the variance. Item communalities were >0.6 in 17 out of 20 items. ICC was 0.90, LoA was ±12.6/16.2 points. The correlations between the M-SFS were 0.89 with the original SFS, 0.49 with the Pain Disability Index, ?0.37 and ?0.33 with the Numeric Rating Scale for actual pain, ?0.52 for selfreported disability due to chronic low back pain, and 0.50, 0.56–0.59 with three distinct lifting tests. No a priori defined hypothesis for construct validity was rejected. Conclusions The M-SFS allows reliable and valid assessment of perceived self-efficacy for work-related tasks and can be recommended for use in patients with chronic MSD. Further research should investigate the proposed M-SFS score of <56 for its predictive validity for non-return to work.     

Same Principles,Different Worlds: A Critical Discourse Analysis of Medical Ethics and Nursing Ethics in Finnish Professional Texts

This qualitative social scientific study explores professional texts of healthcare ethics to understand the ways in which ethical professionalism in medicine and nursing are culturally constructed in Finland. Two books in ethics, published by Finnish national professional organizations—one for nurses and one for physicians—were analyzed with the method of critical discourse analysis. Codes of ethics for each profession were also scrutinized. Analysis of the texts sought to reveal what is taken for granted in the texts as well as to speculate what appeared to be relegated to the margins of the texts or left entirely invisible. Physicians’ ethics was discovered to emphasize objectivity and strong group membership as a basis for ethical professionalism. The discourses identified in the physicians’ ethics guidebook were universal ethics, reductionism, non-subjectivity, and threat. Nursing ethics was discovered to highlight reflectivity as its central focus. This idea of reflectivity was echoed in the identified discourses: local ethics, enlightenment, and moral agency. The analysis exposes a cultural gap between the ethics discourses of medicine and nursing. More work is needed to bridge ethics discourses in Finland in a way that can support healthcare professionals to find common ground and to foster inclusivity in ethical dialogue. Further development of bioethical practices is suggested as a potential way forward.     

The validity of the Satisfaction with Life Scale in adolescents and a comparison with single-item life satisfaction measures: a preliminary study

Purpose

The validity of the life satisfaction measures commonly used among adults has been rarely examined in adolescent samples. The present research had two main goals: (1) to evaluate the structural validity of the Satisfaction with Life Scale (SWLS) among adolescents and to test measurement invariance across gender; (2) to compare the criterion and convergent validity of the SWLS and single-item life satisfaction measures among adolescents.

Methods

Three samples of Serbian adolescents were recruited for the present research. Study 1 (N = 481, M _age = 17.01 years) examined the structure of the SWLS via confirmatory factor analysis (CFA) and evaluated measurement invariance of the SWLS across gender by a multi-group CFA. Study 2 (N = 283, M _age = 17.34 years) and Study 3 (N = 220, M _age = 16.73 years) compared the convergent validity of the SWLS and single-item life satisfaction measures.

Results

The results of Study 1 supported the original one-factor model of the SWLS among adolescents and provided evidence for strong measurement invariance of the SWLS across gender. The findings of Study 2 and Study 3 showed that the SWLS and single-item measures were equally valid and strongly associated (r = .734 in Study 2 and r = .668 in Study 3). No substantial differences in correlations with school success and well-being indicators were found between the SWLS and single-item measures.

Conclusions

Our findings support the use of the SWLS among adolescents and indicate that single-item life satisfaction measures perform as well as the SWLS in adolescent samples.

     

Microcystin Bioaccumulation in Freshwater Fish at Different Trophic Levels from the Eutrophic Lake Chaohu,China

The spatial and temporal variations of microcystins (MCs) in fishes with different trophic levels were studied monthly in Lake Chaohu in 2014. MCs content in muscle was highest in phytoplanktivorous Hypophthalmichthys molitrix (H. molitrix), followed by omnivorous Carassius auratus (C. auratus), and was lowest in herbivorous Parabramis pekinensis (P. pekinensis) and carnivorous Coilia ectenes (C. ectenes). MCs concentration in liver was highest in C. auratus, followed by H. molitrix, and was lowest in P. pekinensis and C. ectene. The main uptake routes of MCs for C. auratus and H. molitrix were via the diet. The mechanism to counteract MCs had not been well developed in C. ectenes. H. molitrix and C. auratus from the western region as they had higher mean concentrations of MCs than fishes from the eastern region. The estimated daily intakes of MCs in 45.4% of muscle samples were higher than the provisional tolerable daily intake set by WHO.     

<Emphasis Type="Italic">AMP!</Emphasis>: A Cross-site Analysis of the Effects of a Theater-based Intervention on Adolescent Awareness,Attitudes, and Knowledge about HIV

AMP! (Arts-based, Multiple component, Peer-education) is an HIV intervention developed for high school adolescents. AMP! uses interactive theater-based scenarios developed by trained college undergraduates to deliver messages addressing HIV/STI prevention strategies, healthy relationships, and stigma reduction towards people living with HIV/AIDS. We used a pre-test/post-test, control group study design to simultaneously assess intervention effect on ninth grade students in an urban county in California (N?=?159) and a suburban county in North Carolina (N?=?317). In each location, the control group received standard health education curricula delivered by teachers; the intervention group received AMP! in addition to standard health education curricula. Structural equation modeling was used to determine intervention effects. The post-test sample was 46 % male, 90 % self-identified as heterosexual, 32 % reported receiving free or reduced lunch, and 49 % White. Structural models indicated that participation in AMP! predicted higher scores on HIV knowledge (p?=?0.05), HIV awareness (p?=?0.01), and HIV attitudes (p?=?0.05) at the post-test. Latent means comparison analyses revealed post-test scores were significantly higher than pre-test scores on HIV knowledge (p?=?0.001), HIV awareness (p?=?0.001), and HIV attitudes (p?=?0.001). Further analyses indicated that scores rose for both groups, but the post-test scores of intervention participants were significantly higher than controls (HIV knowledge (p?=?0.01), HIV awareness (p?=?0.01), and HIV attitudes (p?=?0.05)). Thus, AMP!’s theater-based approach shows promise for addressing multiple adolescent risk factors and attitudes concerning HIV in school settings.     

Interpersonal Responses and Pain Management Within the US Military

Purpose Chronic pain poses a significant problem for the US military. The benefits of self-management treatments for chronic pain are well-documented, but interpersonal responses also influence physical and psychological health and may not be addressed through self-management treatments alone. The current study examines whether perceived interpersonal responses to pain, as measured by the Multidimensional Pain Inventory (MPI), change as a result of participation in an intensive pain management program. It was hypothesized that interpersonal responses to pain would be significantly correlated to psychosocial and physical pain outcomes and that interpersonal responses to pain would change significantly for completers of a functional restoration (FR) program compared to those who were randomized to treatment-as-usual in the military medical system. Methods Forty-four participants were randomly assigned to one of two treatment groups. One treatment group received FR (n = 26) and the other group received treatment-as-usual (n = 18). Significant other responses to chronic pain were measured by the MPI (Pain 23(4):345–356, 1985). Participants also completed measures of impacted quality of life, reported disability, psychological distress, fear avoidance, pain interference, and physical activity. Results Perceived higher punishing responses from a significant other were significantly related to worse physical health-related quality of life (p = .037), work-related fear avoidance (p = .008), pain interference (p = .026), affective distress (p = .039), and pain while lifting (p = .017). Perceived higher solicitous responses from significant others were significantly associated with lower mental health-related quality of life (p = .011), household activity (p = 017), general activity (p = .042), self-reported disability (p = .030), lifting capacity (p = .005), and aerobic capacity (p = .009). Conclusions While findings are preliminary and of limited scope, it appears that the perception of significant others’ responses may be impacted by psychosocial and physical pain outcomes and may change after treatment. More work in this area is needed to uncover the benefits one might achieve when a significant other is included within the FR treatment framework.     

Health-related quality of life in coronary heart disease: a systematic review and meta-analysis mapped against the International Classification of Functioning,Disability and Health

Background

Health-related quality of life (HRQoL) is an important outcome in coronary heart disease (CHD). However, variability in HRQoL indicators suggests a need to consider domain coverage. This review applies a globally accepted framework, the International Classification of Functioning, Disability and Health (ICF), to map HRQoL measures that are reliable and valid among people with CHD.

Methods

The Embase, Pubmed and PsycInfo databases were searched, with 10 observational studies comparing HRQOL among 4786 adults with CHD to 50949 controls identified. Study reporting quality was examined (QualSyst). Hedges’ g statistic (with 95% CIs and p values) was used to measure the effect size for the difference between group means (≤?0.2 small, ≤?0.5 medium, ≤?0.80 large difference), and between-study heterogeneity (tau, I² test) examined using a random effects model.

Results

Adults with CHD reported lowered HRQoL (g_w?=???0.418, p?<?0.001). Adjusted mean differences in HRQoL ratings, controlling for socio-demographics, were smaller but remained significant. Large group differences were associated with individual measures of activity and participation (WHOQOL g?=???1.199, p?<?0.001) and self-perceived health (SF 36 g?=???0.616, p?<?0.001).

Conclusions

The ICF provides a framework for evaluating and understanding the impact of CHD on HRQoL. The results demonstrate that HRQoL goes beyond physical symptoms, with activity limitations, social support and participation, and personal perceptions identified as key ICF domains in CHD assessment. Further investigations are needed to unravel the dynamic and inter-relationships between these domains, including longitudinal trends in HRQoL indicators.

     

Do Intervention Programs in Child Care Promote the Quality of Caregiver-Child Interactions? A Meta-Analysis of Randomized Controlled Trials

This meta-analysis reports on the effectiveness of targeted interventions focusing on child care professionals to improve child care quality, caregiver interaction skills, and child social-emotional development. Within randomized controlled trials, interventions are moderately effective in improving overall caregiver-child interactions (k?=?19, Hedges’ g?=?0.35) and in improving child care quality on the classroom level (k?=?11; Hedges’ g?=?0.39), the caregiver level (k?=?10; Hedges’ g?=?0.44), and the child level (k?=?6; Hedges’ g?=?0.26). Based on these findings, the implementation of evidence-based targeted interventions on a larger scale than currently exists may lead to better social-emotional development for children under the age of 5 years. There remains, however, an urgent need for more and larger randomized controlled trials with a solid design and high quality measures in order to shed more light on which child care components for which children are most critical in supporting children’s socio-emotional development.     

Correlates of Physical Activity Differ by Sex and Country of Birth Among Mexican-Heritage Youth

Barriers to physical activity (PA) may be experienced differently by sex and country of birth. We examine psychosocial correlates of PA in four groups based on sex (boy/girl) and country of birth [Mexico/United States (U.S.)]. 1154 Mexican heritage adolescents residing in Houston, Texas provided psychosocial data in 2008–09 and PA (number of days per week active for at least 60 min) in 2010–11 (N = 1001). Poisson regression models were fitted for each groups. Among boys, English language preference (p _US-born  = 0.045, p _Mexico-born  = 0.008) and higher subjective social status (p _US-born  = 0.002, p _Mexico-born  = 0.031) were associated with increased PA. Body image dissatisfaction was associated with decreased PA in Mexico-born girls (p = 0.007). Sensation-seeking tendencies were associated with increased PA among all groups; anxiety was associated with decreased PA among all but U.S.-born boys. Tailoring PA interventions to key sex-specific psychosocial correlates rather than country of birth may enhance efficacy of interventions to increase PA levels among Mexican heritage adolescents.     

Mindful creativity matters: trajectories of reported functioning after severe traumatic brain injury as a function of mindful creativity in patients’ relatives: a multilevel analysis

Objective

The objective of the present investigation was to examine the association of mindful creativity with the trajectory of recovery (emotional, interpersonal, cognitive, and total functioning) of patients with severe TBI.

Methods

This was drawn from a subsample of an adult prospective cohort study on severe TBI in Switzerland; patients and their relatives were assessed at 3, 6, and 12 months (patients N = 176, relatives N = 176). Predictor measures were assessed using Mindful Creativity Scale—short form and time (trajectory of functioning of the patient over time). Outcome measures were assessed using Patient Competency Rating Scale for Neuro-rehabilitation (PCRS-NR; measuring emotional, interpersonal, cognitive, and total functioning post-injury). All measures were assessed at each time point. Mixed linear models were run separately for ages >50 and ≤50 (i.e., bimodal distribution).

Results

Patients’ mindful creativity showed no significant association with patients’ functioning across time in any of the models. In all age groups, interpersonal functioning decreased across time (slope_>50 = ?4.66, p = .037; slope_≤50 = ?7.19, p = .007). Interestingly, in age group ≤50, interpersonal functioning increased when looking at relative mindful creativity by time (slope = 1.69, p = .005). Additionally, relatives mindful creativity was significantly associated with patients’ functioning in age group ≤50: (a) patients’ total functioning (slope = 0.18, p = .03) and (b) cognitive functioning (slope = 0.72, p = .020).

Conclusions

Relatives’ mindful creativity was significantly associated with patients’ functioning after severe TBI. Implications for treatment and future research are discussed.

     

Reliability and validity of self-reported physical activity in the Nord-Trøndelag Health Study (HUNT 2)

Background

To validate the physical activity (PA) questionnaire in Nord-Trøndelag Health Study (HUNT 2).

Methods

The questionnaire was administered twice to a random sample of 108 men aged 20–39 and validity by comparing results with VO_2max and ActiReg, measuring PA and energy expenditure and with the International Physical Activity Questionnaire (IPAQ).

Results

Spearman correlation coefficients indicated poor and moderate significant agreement by test-retest (light activity, r = 0.17, and hard activity, r = 0.50). We found a moderate significant correlation r = 0.46 (p ≤ 0.01) between hard PA and VO_2max and n.s for light activity (r = ?03). Metabolic equivalent (METs) values 6+ from ActiReg most strongly correlated with hard PA r = 0.31 (p ≤ 0.01), though associations of other measures obtained from ActiReg with questionnaire measures were weaker. Occupational activity was strongest correlated for METs 3–6 r = 0.48 (p ≤ 0.01) by ActiReg.

Conclusions

The HUNT 2 question for “hard” LTPA has acceptable repeatability and appears to be a reasonably valid measure of vigorous activity, as reflected in moderate correlations with several other measures including VO_2max, and with corresponding results from IPAQ and ActiReg. The HUNT 2 question on occupational activity had good repeatability and appears to best reflect time spent in moderate activity, with moderate associations with measured time at intermediate intensity levels. The “light” activity question from HUNT 2 had poor reproducibility and did not correlate well with most of the comparison measures. Thus, the “hard” PA and the occupational activity question should be useful measures of vigorous PA, if time and space allow only very brief assessment. The utility of the “light” PA questions remains to be established.